Our Summary

This research paper is about the surgical treatment of a condition called proximal hypospadias, a birth defect in boys where the urinary opening is on the underside of the penis, rather than at the tip. This can often cause the penis to curve downwards, a condition known as ventral penile curvature (VPC).

The paper discusses two main methods for treating the curvature during the first stage of a two-stage surgery to fix the issue: shortening the top side of the penis or lengthening the underside. Recent studies have shown that both methods have low rates of the curvature returning.

The authors suggest that the shortening method may be best for mild to moderate curves, while lengthening should be saved for severe cases. They also note that lengthening with grafts (tissue taken from another part of the body) has been linked to complications during the second stage of the surgery. There’s a newer lengthening method that involves making relaxing incisions in the corpora (the two cylindrical structures within the penis), but more long-term studies are needed to know if this is safe.

The paper concludes that there isn’t yet a clear guidance on which method is best, but current literature suggests good results with both shortening and lengthening techniques. They recommend using the shortening technique for milder curves (less than 45 degrees) and saving the lengthening technique for more severe curves (more than 45 degrees).

FAQs

  1. What is the first stage of a 2-stage proximal hypospadias repair?
  2. What are the options to correct residual ventral penile curvature (VPC) during hypospadias repair?
  3. What approach is suggested to correct VPC during the first stage of hypospadias repair after division of the urethral plate?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hypospadias repair is to follow post-operative care instructions carefully to ensure proper healing and avoid complications. This may include keeping the surgical area clean and dry, avoiding strenuous activity, and attending follow-up appointments as scheduled. It is also important to communicate any concerns or changes in symptoms to the healthcare provider promptly.

Suitable For

Patients with proximal hypospadias and residual ventral penile curvature (VPC) are typically recommended for hypospadias repair. The first stage of the repair involves division of the urethral plate and correction of any residual VPC. Options for correcting residual VPC include dorsal corporal shortening or ventral corporal lengthening techniques. Patients with mild to moderate residual VPC (<45°) after division of the urethral plate may benefit from dorsal plication techniques, while those with severe residual VPC (>45°) may require ventral corporal lengthening. It is important for patients to be evaluated by a healthcare provider to determine the best approach for their specific case.

Timeline

Before hypospadias repair:

  1. Diagnosis of hypospadias during infancy or early childhood
  2. Evaluation by a pediatric urologist to determine the severity of the condition
  3. Discussion with parents about treatment options and potential risks
  4. Preparation for surgery, including pre-operative testing and consultations

After hypospadias repair:

  1. Surgery to correct the hypospadias, including division of the urethral plate and correction of any ventral penile curvature
  2. Post-operative care, including monitoring for complications such as bleeding, infection, or urinary problems
  3. Follow-up appointments with the pediatric urologist to assess healing and address any concerns
  4. Possible need for a second stage of surgery to complete the repair, if necessary
  5. Long-term follow-up to monitor for any potential issues with urinary function or penile appearance.

What to Ask Your Doctor

  1. What are the different options for correcting residual ventral penile curvature (VPC) during the first stage of hypospadias repair?
  2. What are the potential risks and benefits of dorsal corporal shortening versus ventral corporal lengthening techniques for correcting VPC?
  3. How do you determine which technique is best for correcting VPC in my specific case?
  4. What are the success rates of dorsal plication techniques versus ventral corporal lengthening in preventing recurrent VPC?
  5. Are there any long-term complications associated with ventral corporal lengthening with grafts or relaxing incisions of corpora for VPC correction?
  6. How soon after the first stage of hypospadias repair can the second stage be performed if ventral corporal lengthening is needed?
  7. What is the expected outcome and recovery time for each technique used to correct residual VPC during hypospadias repair?

Reference

Authors: Schlomer BJ. Journal: Curr Urol Rep. 2017 Feb;18(2):13. doi: 10.1007/s11934-017-0659-x. PMID: 28213855